1、作業(yè)治療評(píng)估講者: 區(qū)啟明梁愛珠香港作業(yè)治療師協(xié)會(huì)二七年十二月昆明 鳴謝：鐘晶晶作業(yè)治療評(píng)估講者: 區(qū)啟明梁愛珠General clinical measures in geriatric OT practice作業(yè)治療常用的臨床量度工具Evaluation of functional performance 對(duì)功能表現(xiàn)的評(píng)估Modified Barthel Index (MBI)Functional Independence Measure (FIM)Lawtons Instrumental Activity of Daily Living (Lawton IADL)Evaluation o

2、f cognition 認(rèn)知的評(píng)估Mini-mental State Examination (MMSE)Evaluation of mood 情緒的評(píng)估Geriatric Depression Scale (GDS-15)General clinical measures in Modified Barthel Index 改良的Barthel 指數(shù)developed by Mahoney and Barthel in 1965Modified by Shah et al in 1989to measure the ability of self-care independence of p

3、atientsadministered by trained personnel rate the performance of a patient in an institutionalized setting through direct observationconsist of 10 self-care items3OT management in Geriatric PracticeModified Barthel Index 改良的BarSelf-Care Activities Feeding Bowel ControlBladder ControlToiletingStair c

4、limbing Grooming Bathing Transfer Dressing Ambulation 4Self-Care Activities Feeding Modified Barthel Index改良的Barthel 指數(shù)5-point likert scale Different weights to reflect the time and amount of actual physical assistance required The total sum of item scores yield 100 indicating complete independence

5、in self-care performanceThe most superior and widely used (Gresham, 1980; Dombory, 1987; Wade, 1988 & Shah, 1989)BI is commonly used by local Occupational Therapists. Over 95% of OT settings use the instrument to measure self care independence of patients5OT management in Geriatric PracticeModified

6、Barthel Index改良的BartModified Barthel Index改良的Barthel 指數(shù)The modified BI (MBI) improved the sensitivity of the BI at both the item and scale levelshigher content reliability = 0.87 of the MBI, than original BIinternal consistency was reported as 0.90 and 0.93 for admission and discharge stroke rehabil

7、itation respectively (Keith, 1988; Shah et al., 1989)6OT management in Geriatric PracticeModified Barthel Index改良的Bart(Shah et al., 1989)7OT management in Geriatric Practice(Shah et al., 1989)7OT managemChinese Barthel Index Introduction中文的Barthel 指數(shù)介紹Chinese Barthel Index是一個(gè)日常生活自我照顧能力的尺度。此尺度共有十項(xiàng)的活動(dòng)

8、，包括進(jìn)食、個(gè)人衛(wèi)生、穿衣、洗澡、如廁、大小便控制、床椅轉(zhuǎn)移、步行和上落樓梯。每個(gè)活動(dòng)的評(píng)級(jí)可分為五級(jí)，不同的級(jí)別代表了不同程度的獨(dú)立能力。最低的是一級(jí)，而最高是五級(jí)。級(jí)數(shù)越高，代表獨(dú)立能力越高。 (Leung, Chan & Shah 2007)8OT management in Geriatric PracticeChinese Barthel Index IntrodChinese Barthel Index Rating Criteria中文版的Barthel 指數(shù)評(píng)分標(biāo)準(zhǔn)基本的評(píng)級(jí)標(biāo)準(zhǔn)： 完全依賴別人去完成整項(xiàng)活動(dòng)。某程度上能參與，但在整個(gè)活動(dòng)的過程中都需要?jiǎng)e人提供協(xié)助才能完成。 能

9、參與大部份的活動(dòng)，但在某些過程中仍需要?jiǎng)e人提供協(xié)助才能完成整項(xiàng)活動(dòng)。除了在準(zhǔn)備或收拾時(shí)需要協(xié)助，病人可以獨(dú)立完成整項(xiàng)活動(dòng)；或進(jìn)行活動(dòng)時(shí)需要?jiǎng)e人從旁監(jiān)督或提示，以策安全?？梢元?dú)立完成整項(xiàng)活動(dòng)而毋需別人在旁監(jiān)督、提示或協(xié)助。注：【整個(gè)活動(dòng)的過程】可介定為有超過一半的活動(dòng)過程【準(zhǔn)備或收拾】是指一些可在測試前后去處理的非緊急活動(dòng)過程 9OT management in Geriatric PracticeChinese Barthel Index RatingChinese Barthel Index Feeding中文版的Barthel 指數(shù)進(jìn)食進(jìn)食的定義是用合適的餐具將食物由容器送到口中。整個(gè)過程

10、包括咀嚼及吞咽。評(píng)級(jí)標(biāo)準(zhǔn)：完全依賴別人協(xié)助進(jìn)食。某程度上能運(yùn)用餐具，通常是匙羹或筷子。但在進(jìn)食的整個(gè)過程中都需要?jiǎng)e人提供協(xié)助。能運(yùn)用餐具，通常用匙羹或筷子。但進(jìn)食的某些過程仍需要?jiǎng)e人提供協(xié)助。除了在準(zhǔn)備或收拾時(shí)需要協(xié)助，病人可以自行進(jìn)食；或過程中需有人從旁監(jiān)督或提示，以策安全。可自行進(jìn)食，而毋需別人在場監(jiān)督、提示或協(xié)助。10OT management in Geriatric PracticeChinese Barthel Index FeedinChinese Barthel Index Feeding先決條件：病人有合適的座椅或靠背支撐食物須放置于病人能伸手可及的盛盤或桌子上進(jìn)食方式：口部

11、進(jìn)食或使用喉管進(jìn)食準(zhǔn)備或收拾活動(dòng)：例子：戴上及除下進(jìn)食輔助器具 考慮因素：哽咽并不視作進(jìn)食的一部份，但如哽咽令安全受到影響，則表現(xiàn)應(yīng)被降級(jí)不需考慮病人在進(jìn)食時(shí)身體是否能保持平衡，但如安全受到影響，則表現(xiàn)應(yīng)被降級(jí)喉管進(jìn)食的過程并不需考慮插入及取出喉管11OT management in Geriatric PracticeChinese Barthel Index FeedinFunctional Independence Measure 功能獨(dú)立性的評(píng)價(jià)Developed by Granger, Hamilton, & Sherwin in 1986 Measure severity of d

12、isability in terms of burden of careReflect both the impact of impairment and ability to compensate for lossesFocus on actual task accomplishmentType and amount of assistance required for effective performance of basic daily living12OT management in Geriatric PracticeFunctional Independence MeasurFu

13、nctional Independence MeasureStructureTwo domains: motor and cognitive 18 functional items6 self-care activities 自我照顧活動(dòng)2 sphincter control 大小便控制3 mobility tasks 轉(zhuǎn)移2 locomotion tasks 運(yùn)動(dòng)2 communication tasks 交流3 social cognition社會(huì)認(rèn)知13OT management in Geriatric PracticeFunctional Independence Measur6 F

14、unction Categories & 18 Items6個(gè)功能范疇及18個(gè)條目Self-careEating Dressing UBGrooming Dressing LBBathing ToiletingSphincter ControlBladder ManagementBowel ManagementTransfersBed, Chair, WheelchairToiletTub or ShowerLocomotionWalk / WheelchairStairsCommunicationComprehensionExpressionSocial CognitionSocial In

15、teractionProblem SolvingMemory14OT management in Geriatric Practice6 Function Categories & 18 IteFIM Scoring: Level of AssistanceFIM 評(píng)分：輔助分級(jí)The NO-HELPER Scores7 = Complete Independence6 = Modified IndependenceThe HELPER ScoresModified Dependence5 = Supervision, Setup or Standby Prompting4 = Minimal

16、 / Contact Assistance or Prompting3 = Moderate Assistance or PromptingComplete Dependence2 = Maximal Assistance or Prompting1 = Total AssistanceTotal Score Range: 18-126Moderately dependent: 10015OT management in Geriatric PracticeFIM Scoring: Level of AssistanGeneral Description of FIM Levels of Fu

17、nction and Their ScoresStartDoes Subject need help?NoDoes Subject need more than reasonable time or a device or is there a concern for safety?NoSCORE 7COMPLETE INDEPENDENCESCORE 6MODIFIED INDEPENDENCEYesNo helperYesHelperDoes Subject do half or more of the effort?YesNoDoes Subject need total assista

18、nce?YesNoSCORE 1SCORE 2TOTAL ASSISTANCEMAXIMUM ASSISTANCEDoes subject need setup or supervision, cueing or coaxing only?YesSCORE 5SUPERVISION OR SETUPNoDoes Subject need only incidental assistance?YesSCORE 4MINIMUM ASSISTANCENoSCORE 3MODERATE ASSISTANCE16OT management in Geriatric PracticeGeneral De

19、scription of FIM LevLawton Instrumental ADL Scale 工具性的ADL量表Developed by Lawton & Brody in 1969Chinese version validated by Tong & Man in 2002 To measure the ability of instrumental activities of daily living independence of patients that are essential for community livingConsisted of 9 itemsAdminist

20、ered by trained personnel Rate the performance of a patient in home and community settingsFormat of administration: self report, proxy, observation, performance-based17OT management in Geriatric PracticeLawton Instrumental ADL Scale Lawton Instrumental ADL Scale工具性的ADL量表Distinct characteristics of I

21、ADLMulti-step & more complex, require high level of social, physical and mental skillsIncreased interaction with environment Failure of performance affects community participation and/or reintegrationPoor IADL predicts poor future health and functional status (Kovar & Lawton 1994)Target populationPr

22、e-discharge, out-patient, community-dwelling older people 18OT management in Geriatric PracticeLawton Instrumental ADL ScaleLawton Instrumental ADL ScaleEqual weights are assigned to each item to reflect the amount of actual assistance or supervision required Performance is rated against a four-poin

23、t scale ranging from score 0 for inability to perform the task to score maximum i.e. 3 for total independenceThe total sum of item scores yield 27 indicating complete independence in instrumental ADLAn average score is usually obtained for interpretation19OT management in Geriatric PracticeLawton In

24、strumental ADL ScaleE日常家居及社區(qū)活動(dòng)能力評(píng)估“你能唔能夠自己用電話呢?” 包括找電話號(hào)碼, 打及接聽電話“你能唔能夠自己搭車呢?” 包括自己上到正確的車, 俾車錢/買車票, 上/落車(假設(shè)你必須要搭交通工具去一個(gè) 遠(yuǎn)的地方例如探朋友 / 睇醫(yī)生) 20OT management in Geriatric Practice日常家居及社區(qū)活動(dòng)能力評(píng)估20OT management i日常家居及社區(qū)活動(dòng)能力評(píng)估“你能唔能夠自己買野呢?”包括自己揀貨品俾錢及攞番屋企(假設(shè)你必須要到附近商店買食物或日用品)“你能唔能夠自己煮食呢?” 包括自己諗食乜準(zhǔn)備材料煮熟食物及放入碗碟裡(假

25、設(shè)你必須要自己準(zhǔn)備兩餐)21OT management in Geriatric Practice日常家居及社區(qū)活動(dòng)能力評(píng)估21OT management i 日常家居及社區(qū)活動(dòng)能力評(píng)估“你能唔能夠自己做家務(wù)呢?” 包括簡單家務(wù)(如抹檯執(zhí)床洗碗)及較重的家務(wù)(如抹地/窗)(假設(shè)你必須要自己做家務(wù))“你能唔能夠應(yīng)付簡單的家居維修呢?” 例如換燈泡維修檯及上緊螺絲等(假設(shè)你必須要自己做)22OT management in Geriatric Practice 日常家居及社區(qū)活動(dòng)能力評(píng)估22OT management 日常家居及社區(qū)活動(dòng)能力評(píng)估“你能唔能夠自己洗衫呢?” 包括清洗及曬自己的衫被床單

26、等(假設(shè)你必須要洗自己的衫,被,床單等)“你能唔能夠自己服用藥物呢?” 包括能依照指示在正確的時(shí)間內(nèi)服用正確的份量(假設(shè)你必須要自己查藥油或食藥等) 23OT management in Geriatric Practice日常家居及社區(qū)活動(dòng)能力評(píng)估“你能唔能夠自己洗衫呢?” 23O日常家居及社區(qū)活動(dòng)能力評(píng)估“你能唔能夠處理自己的財(cái)務(wù)呢?” 包括日常錢銀的找續(xù)交租/水電費(fèi)及到銀行提款(假設(shè)你必須要買自己交租/水電費(fèi)及有將錢放在銀行) 24OT management in Geriatric Practice日常家居及社區(qū)活動(dòng)能力評(píng)估24OT management iLawton Instrum

27、ental ADL Scale Rating CriteriaScore 3 : independent to do 獨(dú)立完成Score 2 : 獨(dú)立完成但是存在困難independent to do but with difficulty (i.e. poor safety; special arrangement needed; verbal prompt needed; slow in speed; seldom to do due to with difficulty but able to do if required)Score 1 : 需要幫助need some help Sco

28、re 0 :unable to do 不能完成25OT management in Geriatric PracticeLawton Instrumental ADL Scale Use of Functional Assessments 功能評(píng)價(jià)的使用Set up a baseline on functional levelProgress monitoringQuantify the changes after interventionDischarge planningPart of decision making of placement recommendations A commu

29、nication tool among settings and disciplines26OT management in Geriatric Practice Use of Functional AssessmentFunctional Assessment 功能評(píng)估Functional performance of older adults in self care and/or instrumental ADL can be restricted due to injury/illness.Supporting clients to attain optimal functional

30、independence is one of the goals for OT geriatric practice.27OT management in Geriatric PracticeFunctional Assessment 功能評(píng)估FunWhat are the common criteria used in functional evaluation? 在功能評(píng)估中的共通標(biāo)準(zhǔn)是什么？What are the common criteria uTHANK YOUSUCCESS2022/10/429可編輯THANK YOUSUCCESS2022/10/22Common criteri

31、a used in functional evaluationIndependence / level of assistance獨(dú)立/需要協(xié)助的分級(jí)Frequency/Amount of physical or verbal assistance that a client asks for during task performance患者在完成指定任務(wù)中所需要體力上的幫助/口頭的提示程度/數(shù)量30OT management in Geriatric PracticeCommon criteria used in functiHow about these criteria? 這些標(biāo)準(zhǔn)怎么

32、樣？Effort 成果 Amount of physical difficulty or fatigue that clients demonstrates during task performanceEfficiency 效率Degree of disorganization, inappropriate use of time and space that clients demonstrates during task performanceSafety 安全性Clients potential of injuring himself or causing damage to envi

33、ronments during task performance31OT management in Geriatric PracticeHow about these criteria? 這些標(biāo)準(zhǔn)Assessment for Cognitive ImpairmentIn Hong Kong, prevalence of moderate to severe dementia is 6.1% in people who aged 70 or above (Chiu et al., 1998)24.6% in high risk elders who are living in institut

34、ion or home (SSP Survey 2005)32OT management in Geriatric PracticeAssessment for Cognitive ImpaiMini-Mental State ExaminationDeveloped by Folstein & Folstein in 1975Bedside screening instrument for detection of cognitive impairmentAdministration time: about 10 minutesReliably tested across different

35、 culturesSensitive to changes33OT management in Geriatric PracticeMini-Mental State ExaminationDMini-Mental State ExaminationComposed of 6 domainsOrientation (time & place)RegistrationAttention & calculationMemory (short term)Language & ComprehensionVisual spatial orientation34OT management in Geria

36、tric PracticeMini-Mental State ExaminationCMMSE - InterpretationGeneralAn aid to document the presence of cognitive impairment or monitor progress of disease Serial MMSE scores is sensitive for progressive mild cognitive problemEducation level, sensory impairments, language and communication problem

37、s may affect the reliability of the test35OT management in Geriatric PracticeMMSE - InterpretationGeneral35MMSE - Interpretation Score30 : no impairment or = 24 : “normal” in general population20-23 : cognitive impaired but still live independently 20 : usually cannot live independently : problems i

38、n instrumental ADL : still manage basic ADL36OT management in Geriatric PracticeMMSE - Interpretation Score3Cantonese MMSE Cantonese version of MMSE was developed by Chiu et al in 1994Some items revised according to the Chinese culture in Hong KongValidation studies conducted for elderly populationC

39、ut-off scores developed according to different education level of subjects37OT management in Geriatric PracticeCantonese MMSE Cantonese versiCantonese MMSE38OT management in Geriatric PracticeCantonese MMSE38OT management Cantonese MMSE現(xiàn)在是什麼時(shí)候?年份季節(jié)月號(hào)數(shù)星期這裡是什麼地方?香港/九龍/新界地區(qū) (深水步 / 長沙灣)醫(yī)院名字部門 層數(shù)39OT man

40、agement in Geriatric PracticeCantonese MMSE現(xiàn)在是什麼時(shí)候?39OT manCantonese MMSE我會(huì)講三種東西的名字給你聽，講完之後請(qǐng)你重覆一次並緊記，因?yàn)閹追昼娽嵛視?huì)問你。蘋果、火車、報(bào)紙你用一百減七，然後再減七，一直減落去直至我叫?！，F(xiàn)在我會(huì)講幾個(gè)數(shù)字請(qǐng)你倒轉(zhuǎn)讀出：我較早前請(qǐng)你記住的三種東西是什麼？40OT management in Geriatric PracticeCantonese MMSE我會(huì)講三種東西的名字給你聽，講完Cantonese MMSE這樣是什麼東西？（手錶 / 鉛筆）請(qǐng)你跟我講句說話，姨丈買魚腸?，F(xiàn)在檯上有一張紙，請(qǐng)

41、你用左(右)手拿起張紙，用雙手對(duì)摺一次，然後放回檯上/交給我。請(qǐng)讀出紙上的字，然後照住去做。（拍手）請(qǐng)你講/寫出一句完整句子。這裡有一幅圖形，請(qǐng)你照住畫。41OT management in Geriatric PracticeCantonese MMSE這樣是什麼東西？（手錶 / 鉛筆CMMSE - Interpretation Cut-off Score22 or below : for elder with more than 2 years of education20 or below : for elder with less than 2 years but more than

42、6 months education18 or below : for elder with less than 6 months of or no education (Chiu et al., 2000) 42OT management in Geriatric PracticeCMMSE - Interpretation Cut-oCharacteristics in different diagnostic groupsAlzheimers DiseaseUsually the first deficits is the short term memoryDisorientation

43、to time and is followed by disorientation to placeLanguage deficits start to appear lateUsually continue to try to get the right answer43OT management in Geriatric PracticeCharacteristics in different dCharacteristics in different diagnostic groupsStrokeDeficits are more patchyNo specific profile Ma

44、y have aphasia / dysphasia (expressive, receptive or global )May have speech / language problems earlier than Alzheimers disease44OT management in Geriatric PracticeCharacteristics in different dCharacteristics in different diagnostic groups - DepressionSeem less distressed than Alzheimers patients

45、about their problemsMore likely to answer “ I dont know” or “it doesnt matter”When pressed they often know the answer Presented with “disability gap”No obvious STM lossOther symptoms: appetite change, energy loss, weight loss, sleep disturbance, mention about suicide, etc.45OT management in Geriatri

46、c PracticeCharacteristics in different dDeveloping the Care PlanProblem with judgment:Get a power of attorney, advance directive and start building a support networkSTM loss:Use reminders, lists, cues, calendars or diariesLanguage difficulties:Avoid open ended questionsAvoid idiomatic expression46OT

47、 management in Geriatric PracticeDeveloping the Care PlanProbleDeveloping the Care PlanWord finding difficulties:Keep language simpleGive adequate time to respondCommunicate one idea at a timeAvoid words with more than one meaning3-step command deficit:Give one instruction / idea at one time47OT man

48、agement in Geriatric PracticeDeveloping the Care PlanWord fWhy the evaluation of mood is important in geriatric practice? 情緒的評(píng)估為什么重要？11 15% of local elderly people showed depressive symptoms (Chi, Yip, Chiu et al., 2005)Poor self-rated health, chronic pain, vision problems, ADL impairment, financial

49、 strain, few social support are associated with an increased likelihood of geriatric depression (Chi, Yip, Chiu et al., 2005) Aversive consequences of depressive mood include increased disability, treatment refusal, suicidal attempts or acts, and a decreased quality of life. 48OT management in Geriatric PracticeWhy the evaluation of mood is Geriatric Depression Scale (Short-form) 老人抑郁短量表Developed by Sheikh & Yesavage in1986 Screening tool for geriatric depressionAssess affective and behavioural symptoms of depressionMainly focus on psychological aspect